This document discusses multiple pregnancies, specifically twins. It defines twins as the simultaneous development of more than one fetus in the uterus. The types of twins are discussed, including dizygotic/fraternal twins which develop from two separate eggs and monozygotic/identical twins which develop from one egg. The risks and complications associated with multiple pregnancies are summarized for both the mother and fetuses. The document concludes with describing the recommended management and care during antenatal, delivery, and postnatal periods for multiple pregnancies.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
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Arkab khan
Placenta Previa is one type of Antepartum Hemorrhage and an obstetrical emergency too... So in health care management having knowledge regarding this topic is very important in Obstetrics.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
Placenta Previa is one type of Antepartum Hemorrhage and an obstetrical emergency too... So in health care management having knowledge regarding this topic is very important in Obstetrics.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Women carrying multiple gestations may be initially asymptomatic or may have normal signs and symptoms of pregnancy (eg, breast tenderness, fatigue, nausea, vomiting). Multiple gestations may be suspected in the setting of hyperemesis gravidarum or in a patient who has undergone assisted reproductive technology.
Asthma Signs and Symptoms, Severity Classification, GINA and ATS Classification, Step-up Management of Chronic Asthma and Management of Acute Exacerbation of Asthma
Delayed blood transfusion reaction is a reaction too blood transfusion occurring after 24 hours. Can be divided to immune mediated and non-immune mediated. Share about the cause, symptoms, investigations and management.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
4. Incidence
Hellin’s Law – Twin = 1:80
Triplets = 1:80²
Quadruplets = 1:80³
Monozygotic = 3-5/1000 births
Dizygotic = varies depending on
maternal age, race and geographical
distribution
5. Aetiology
Assisted reproduction techniques
Increase parity
Increase maternal age
Family history
Previous multiple pregnancy
African race
6. Type of multiple pregnancy
Dizygotic / binovular / fraternal
2. Monozygotic / Uniovular / identical
1.
7. Types of Monozygotic twins
1. Dichorionic Diamniotic :
i. Division occurs with in 72 hrs of fertilization
ii. May have 2 diff placentas/ single fused placenta
iii.Difficult to differentiate form dizygotic twins
iv.Both babies have same sex
2. Monochorionic Diamniotic:
I. Division occurs with in 4 – 8 days of fertilization
8. 3. Monochorionic Monoamniotic:
I. Division occurs 9-12 days of fertilization
4. Conjoined twins:
I. Division occurs after 13th day
II. Incomplete division of embryonic disc
III. Types: -thoracopagus
- omphalophagus
-craniopagus
-pyopagus
-ischiopagus
9. Monozygotic / Uniovular / Identical
Dizygotic / binovular / fraternal
1.1/3 twins
1.2/3 twins
2.1 sperm and 1 ovum
2.2 sperms and 2 ova
3.Identical
3.Dichorionic Diamniotic
twins
4.Type of placenta depends
on the time of splitting of
embryo
4.Presence of chorionic tissue
between 2 amniotic sac
5.Incidence is dependent of
5.Incidence is independent of race, age, parity, and
race, age, parity
ovulation inducing drugs
11. SIGNS :
• Anemia
• Edema
• Abnormal Weight Gain
• Uterine Height > POG
It may be normal size in case of binovular twins/ when 1 of
the babies die in utero
Palpation:
Feel 2 separate heads/ > 2 poles
Auscultation :
2 FHS with difference of at least 10 beats heard on 2 sides of
uterus by 2 people, at least 6 inches away
12. Role of ultrasound
Confirmation of chorionicity
Twin peak sign / Lambda sign = dichorionic placenta
Identify the number and site of placenta, fuse or
separate
Lie and presentation of twin
Amniotic fluid assessment
17. Twin to Twin Transfusion
Syndrome
Occur in 10-15% of monochorionic twins
Mostly during 2nd trimester
Due to imbalance of blood flow across placental
AV anastomosis
Symptoms : sudden increase girth a/w extreme
discomfort
Signs : tense uterus with excessive
liquor volume
Ultrasound : Polyhydramnios in
recipient.Oligohydramnios in donor
18. Donor twin
Recipient twin
Hypovolemic & oliguric/anuric
Hypervolemic & polyuric
Result in stuck twin phenomenon
where the twin appears in a fixed
position against uterine wall
Can also develop HTN,hypertrophic
cardiomegaly,disseminated
intravascular coagulation,and
hyperbilirubinemia after birth
Ultrasound may fail to visualize fetal
bladder because of absent urine
Both twin can develop hydrops foetalis
Donor can become hydropic because of
anemia and high output heart failure
Recipient becomes hydopic because of
hypervolemia
19. Single Fetal Demise
> in Monochorionic twin
If one twin dies after 14wk,there is high risk of
neurological damage to survivor twin : due to
thromboplastin release thrombotic arterial
occlusion of ant & middle cerebral arteries
multicystic encephalomalacia
20. Management of multiple
pregnancy
Antenatal care :
Extra attention & diet: at least 300 kcal more than in
normal pregnancy
Routine iron and folic acid
Detailed anomaly scan followed by serial growth scan
at 28, 32 and 36 week
Hospitalization if suspected pretem
21. RCOG recommended antenatal
care
Dichorionic
Monochorionic
-Lead clinician with multidisciplinary
team
-Lead clinician with multidisciplinary
team
-US at 10-13wk :
viability,chorionicity,NT:aneuploidy
US at 10-13wk :
viability,chorionicity,NT:aneuploidy/T
TTS
-Structural anomaly scan at 20-22wk
-US surveillance for TTTS and
discordant growth at 16wk and then
2weekly
-Serial fetal growth scan eg:24,28,32
then 2-4weekly
-Structural anomaly scan 20-22wk
(including fetal ECHO)
-BP monitoring and urinalysis at
20,24,28 and then 2weekly
-fetal growth scan 2wkly interval until
delivery
-Discussion of mother’s/family needs
relating to twins
-BP monitoring and urinalysis at
20,24,28 then 2weekly
22. Timing of delivery
Uncomplicated dichorionic – by
38 week
Uncomplicated monochorionic –
by 37 week
TTTS – depend on current
situation
MCMA – 32 week, by LSCS
23. Mode of delivery
Depend on presentation of 1st twin
Both vertex / 1st twin vertex –
vaginal delivery
Indication for Elective LSCS
-More than 2 fetuses
-1st twin malpresentation, CPD
-Scarred uterus
-MCMA
-Conjoint twin
-IUGR in dichorionic twin
-TTTS
24. Emergency LSCS :
-Fetal distress
-cord prolapse in 1st baby
-Non progress of labor
-2nd twin is transverse, version failed after
delivery of 1st twin
25. Management during labour 1st
stage
1.
2.
3.
4.
5.
6.
Determine the presentation of 1st twin
Maintain partogram
Keep NBM and establish IV line
Blood grouping and cross matched
Continous intrapartum twin CTG monitoring
Analgesic
26. Management during labour 2nd
stage
1. Delivery of 1st twin
2. Clamp and cut the cord
3. Note lie of the 2nd twin (delivered within 20 min)
4. Longitudinal lie (abdominally & vaginally) :
Start 2 units of pitocin IV drip
Cephalic Fix the head into pelvisARM &
deliver the fetus
Breech Assisted breech delivery, Breech
extraction
27. If 2nd twin has transverse lie :
•
•
•
•
Assistant performs ECV.
Fix the head in lower pole of the uterus and accoucher
performs controlled ROM (rupture of membrane)
If this fails: do IPV (internal podalic version) followed
by breech extraction
Or proceed with emergency LSCS